Taulinoplasty or Pectus Up has great advantages and is still a real revolution in the world of thoracic surgery and more specifically in the surgical treatment of Pectus Excavatum, because it is a quick procedure (approximately 60 minutes of surgery), minimally invasive and with a lower requirement for post-surgical analgesia. The patient's recovery is much faster.
It is a technique that is practiced by a small incision, with minimal blood loss, that avoids entering the thorax, with which there is no risk of affecting the internal organs and with excellent results and satisfaction, not only for the patient but also for the professionals who carry it out.
In the words of Dr. Núñez, current Coordinator of the Pediatric Thoracic Surgery service: "Since it was described in 2012, Taulinoplasty has revolutionized the surgical treatment of Pectus Excavatum, although it is not indicated in all patients, so it is essential to thoroughly individualize and study each case in order to provide the best surgical treatment."
Of course, each case must be individualized and studied, because no two patients are alike. Surgical correction should be considered appropriately and by pediatric surgeons skilled in the field, such as those of the Parc Taulí Health Corporation.
Currently the Nuss technique is our technique of choice, but we believe that Taulinoplasty can be ideal in patients with Pectus Excavatum with a slight funnel or sinking in the sternum and symmetrical lower third; or patients who want to avoid the Nuss technique.
In asymmetric patients with extreme sagging, Haller indexes above 10 or very severe, Taulinoplasty is not indicated as the first surgical option, and we perform the videoassisted technique described by Nuss, a technique in which our Corporation's thoracic pediatric surgeons Parc Taulí have extensive and recognized experience.
In addition to studying and individualizing each case, and making a good medical history, at the Parc Taulí Health Corporation where we have a wealth of experience and a good multidisciplinary team, we will request:
- Un scan or thoracic CT scan where objective measurements will be performed (the Haller Index being the most widely used).
The Haller index is the relationship between the transverse diameter (the horizontal distance inside the rib cage) and the anteroposterior diameter (the shortest distance between the spine and the sunken sternum) in the cut of maximum chest collapse. . A Haller index equal to or greater than 3,25 is already defined as moderate and may be an indication for the surgical treatment of pectus excavatum.
- A ergo / spirometry to study lung capacity and to see if there is any restrictive pulmonary component associated with Pectus Excavatum.
- A echocardiography. To study the cardiac thoracic component.
Pectus Excavatum can manifest itself at any time in childhood and with varying degrees of involvement.
There are practically patients asymptomatic, with slight deformity, but with more or less significant aesthetic implications; and patients with one moderate or severe involvement, that they could suffer physical problems and / or important psychological alterations.
Families (parents or grandparents) are often the first people to notice the sunken chest.
The pediatrician will be the first professional consulted by these families to find information and answers about the Pectus Excavatum. And this one will be the one who sends us to the External Consultation for Pediatric Thoracic Surgery (Pectus Unit).
Normally in patients younger than 5-6 years and if they are asymptomatic, no complementary test is usually performed other than clinical evolutionary follow-up. From this age on, we understand that it is important to do an annual review and see if the defect has stabilized or is progressive. If the defect increases or there are symptoms related to Pectus Excavatum, it should be evaluated more deeply as surgical treatment around puberty may be required.
Adolescence is the key moment, when the whole body is growing and its sternal position can change.
Pectus Excavatum surgery will be indicated in the following situations: Haller index equal to or greater than 3.25, Correction Index of more than 20%, progression of the deformity, existence of a restrictive or obstructive lung disease, previous failure in treatment of Pectus Excavatum, compression or cardiac displacement, mitral valve prolapse, or severe psychological problems in terms of aesthetics.
At Corporació Sanitaria Parc Taulí we are well aware that having a sunken chest can be a serious problem in the psychological development of children and adolescents that can even lead them to shy away from the beach or always go with a T-shirt. And at this point, we try to give it a lot of value in order to decide whether or not a surgical treatment is indicated.
The last decision, whether to intervene or not, when medically indicated, is always the patient's (in our case, usually the parents').
No Pectus Excavatum patient is operated on for an aesthetic defect only.
If one does not want to intervene, for fear of surgery or pain, it is worth knowing that there are multiple aesthetic options that seek to fill the defect and sternum funnel with different types of materials or products, although they are not made at the Corporación Sanitaria Parc Taulí, because we believe that they are not the definitive solution to the problem (raise the sternum to its natural position).
Silicone molds, vacuum hoods, hyaluronic acid injection gels, centrifuged fat, etc. can be used. Some of these materials have the disadvantage that they must be replaced over time (one or two years, as they are reabsorbed).
Practicing a lot of sports, swimming, postural measures… without a doubt are highly recommended.
The truth is that relocating the sternum in its position hurts, although (and pending the publication of results comparing the analgesic requirements between patients with PE operated on by Nuss technique and by Taulinoplasty), the latter have required a shorter time to enter in ICU and have shown less need for painkillers. In fact, patients who have undergone the Taulinoplasty technique have been able to go home much earlier.
In any case, thoracic epidural anesthesia is performed during the intervention. This will allow you to leave a catheter attached to an apparatus that will provide medication for the treatment of acute postoperative pain for the first 48 hours. As a rule on the third day, intravenous alternating medication is usually withdrawn and left and between the 4th and 5th days discharged with oral analgesia (ibuprofen).
After the days of admission, the patient will be visited in Outpatient Consultations for 10 to 15 days of the surgery to control and remove the intradermal suture and see that everything is going well and to study that the body is adapting well to the surgery chosen.
Then you will have one new visit per month and another two months. Until then, you will NOT be able to do ANYTHING of physical activity. Later, you can play sports, although it is always advisable to avoid any risky practice or contact sports, but you can lead a completely normal life.
The follow-up will be 2 or 3 years until the surgical material is removed.
Scar right after the operation
Appearance of the scar after a while
It can be left permanently, as the plate, unlike the Nuss bar, does not prevent the rib cage from growing, although our recommendation always will be to remove it for about 2 -3 years of the operation, since it has already performed its function.
Numerous plates have been removed since 2012 and no sternum has been sinked again. We are aware that such fear exists, as with the removal of the Nuss bar, but the plate, once performed, must be removed.
The incision is the same as the previous surgery, but it hardly hurts and the admission is usually 24-48h.